Category Archives: random musings

The Dark Side of Travel Nursing

So, I have been doing travel nursing again for essentially the past year. It has been mostly awesome. I spent 9 months in Houston, Texas, and most recently have come to St. Louis, MO. I have loved it. I have loved the freedom of working a contract and being able to take time off if needed, I have loved exploring new cities and meeting new people. It has been overall a wonderful experience!

Most recently (as in last week) though, the dark side of travel nursing reared it’s ugly head. Insecurity. Lack of benefits. No safety net. I had a “health incident”, which landed me in the hospital, on the other side of the rail so to speak. My shift started out as they usually do, getting report and developing my plan for the night. Midway through my shift though, I was having really bad chest pain. I had been feeling badly most of the week, increased heart palpitations, massive fluid retention, heartburn and fatigue. I had been chalking it up to overworking as I had been fairly consistently putting in 60+ hours per week for a while. As I stood there talking to the NP about my patient, I kept rubbing my chest unconsciously. She noticed and asked me about it, and proceeded to march me into an empty room. I took my blood pressure which prompted and “Oh my god Sarah, is that your pressure!?”. Needless to say it was a bit high. The long and short of it was, without me even being aware of it, she orchestrated someone to come in and take my patients and send me to the ER. I was furiously charting trying to catch up and they even snapped a photo of me with oxygen on refusing to get in the wheelchair until my assessment was completed.

I went to the ER, and went through the whole shebang. Because I have lupus, and I have been off my meds for 3 months, everyone started jumping up and down that I need to be admitted. Needless to say I was non-plussed. The first thing I thought of was “I can’t miss any work”. See, the dark side of travel nursing is, if you don’t work you don’t get paid. Additionally, if you opt for their housing, you can face penalties for missing your hours to supplement their expenses at maintaining your apartment. It is a very scary prospect to be a patient in the hospital, and even more so when you are facing financial issues to boot. After much foot dragging and arguing, I agreed to be admitted (have I mentioned I am a HORRIBLE patient?). My cardiac enzymes were negative, but based on my symptoms and my lupus, the doctors felt strongly that I needed a dobutamine stress echo. I will spare you the gory details, but suffice it to say, that was one of the worst experiences of my life. Nobody should ever have their heart go from 56 beats per minute to 176 beats per minute in the span of 2 minutes. I thought I was going to die. I cried.  A lot. And almost vomited on the tech, poor thing. By the time I got back up to my room, my blood pressure was so dangerously low I almost fainted in the wheelchair. Scared the poor CNA to death, but somehow managed to levitate my ass to the bed before collapsing. My blood pressure never came up to normal, and continued to be very abnormally low. I requested enzymes with my PM labs, because I truly felt like I had been having a heart attack during the stress test.

Needless to say, my stress echo was “abnormal”, much to the surprise of everyone. The cardiologists honestly thought they were just going through the paces and I would go home that day. I did not go home. They scheduled me for cardiac cath the following day, which absolutely terrified me. See, the problem with being a nurse, is you know too much. On one of my travel assignments , I sent a lovely lady to cath lab, and she never came back. I get report and transfer of all the patients with “complications” post cath. Scares the bejesus out of me. Later that night, about 1am, doctors came tiptoing in (always right when I need to go to the bathroom, like toddlers or cats), and went “ah well, tell us more about what happened during your stress test”. Suddenly everyone was interested to hear what I had tried to tell them before. Turned out I had a small MI during the test. By this point,  I felt like they were trying to kill me, to be honest. My enzymes had been negative up to that point, but their test suddenly has everyone going “um don’t get out of bed and here is a heparin drip”.  Through all of this though, my amazing friends and coworkers really saved the day. From listening to me freak out, visiting me at night when I couldn’t sleep, to making sure I was with the best interventional cardiologist for my cath, these nurses saved me. See, they didn’t see “a traveler”. They saw a fellow nurse, scared to death, and took care of me. Even my boss, went to cath lab to make sure everyone knew I worked there, came to see me, and hugged me when I was losing my shit before going to cath lab. All I wanted to do was go home….but these people kept me sane.

The next day I went for my cath. I asked for a radial approach, to have faster healing time. The cardiologist didn’t want to do it because of my Reynaud’s, but he did anyways (I begged). Turned out he was right and I should have listened to him, it hurt like a son of a bitch and still does. The long and the short of it was I apparently had a 68% blockage midway down my LAD. the put a stent in, and now I am on plavix and aspirin, with the lovely diagnosis of Coronary Artery Disease and Non Stemi Myocardial Infarction. There are no other lesions anywhere, and most likely the pain I have been having for a long, long time has been vasospasms. See, I never paid attention to my “chest pain” because it wasn’t like what I thought of as chest pain. I could point to where it hurt. Apparently that spotI could point to was halfway down my LAD. The doctor said it was a little hidden, but that I was extremely lucky considering this was in the main artery of my heart.

All of this has been overwhelming to say the least. I can’t wrap my head around the idea that at 44, with no family history, normal blood pressure, perfect cholesterol that I am a cardiac patient. Yes I am fat- have always been so. But being fat in and of itself doesn’t clog your arteries. Turns out, the pesky Lupus does. For some unknown reasons, the near constant inflammation I experience from my Lupus is worse on my arteries then having bad cholesterol. This coupled with chronic arterial vasospasms led to me needing a stent. It is possible the “benign” heart arrhythmia I have had all these years was in fact this lesion developing. Being off the meds that reduce inflammation levels in my blood exacerbated all of this. Luckily, statins also help with inflammation, also for unknown reasons. So if I take my meds like a good girl I should be fine. Mind you, I stopped them because they were making me fat. Because we live in a society where it is better to be dead than fat. That is a blog post for another day, however.

They say that experiencing a profound health crisis changes you. I don’t know that it has changed me per se, but it is definitely giving me pause to rethink things. While I love travel nursing, it is a bit like playing Russian Roulette. Unless you are smart and have 6 months of salary saved up (and face it, who among us does?), you run the risk of losing everything if you can’t work. There is no safety, no backup, no net. None of us are immune, no matter how indestructible we think we are. This experience has taught me that it is ok to be a little selfish. To think about my needs first before others. I need to get back to classes and finish school (I am going for my RN to MSN, then NP). I need to have a less stressful job. I need to make more money so I can work smarter instead of harder. The days of “well I will just pick up an extra shift” as the answer to all the financial woes must stop. I cannot be this workhorse anymore. I need some safety and security in my life, as much as is possible in this crazy world to have.

I also realized I have been afraid to share what has been going on, because of the stigma associated with CAD. I know, that people assume by looking at me that I “ate myself” into a heart attack. I also know that the people who love and care for me know that is not true. I probably have better eating habits than most of the people I know. I avoid meat, fat, eat lots of veggies etc. I loathe cheeseburgers and mayo, and usually get chased after to eat something. Obesity is a complicated thing, and not easy to deal with. I had been losing weight fairly consistently after getting off the steroids, until the new Lupus meds- then over 9 months I gained 45 pounds back.  No matter what I did, how I restricted my diet, what exercise I did, I gained. According to my fitbit  I would hit my 10K steps in the first 4 hours of work.  I gained in weird places, not normal to me. So I went off my meds. In my mind, I could be ouchy and fat, or ouchy with Lupus, what was the difference? What I didn’t stop to think about was the hidden effect the Lupus was having on my body. The insidious inflammation and destruction of the unseen parts of my body. Sure, I started to lose weight again, slowly, but at what price?

So now, I am going back to work tonight. Nervous, only with a week recovery. Could I use more time off? Sure! Who couldn’t? But the sad truth is I can’t afford it. One week without pay was all I could do. While I adore travel nursing, and part of me wants to continue jetting around the world to exciting locals, meeting new people and seeing new places- I realize that I need to slow down and reconsider. The sad truth is I can’t “afford” to do travel nursing anymore. I need to seriously investigate a permanent position until I am finished with school. I need to get back on that bandwagon ASAP so I can finally have some viable financial options that offer nursing away from the bedside, but not in administration which I loathe with all my soul. Luckily, I love it here in St. Louis. I adore the people I work with, the unit, my boss, the hospital, the city. I am lucky I have support here and the backup to take a perm position. Hopefully that will work itself out by the end of this contract. I am still waiting to hear from HR, apparently they move glacially slow. But hopefully this will turn into something even better for me then I have had before. Meanwhile, it’s back to the grind, albeit at a little slower pace.

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Perhaps to Travel Again

So, the hunt begins. Finally, we are at the home stretch to be able to travel again. It has been a long process, working this past year towards getting my husband’s papers permit so he can travel too.

I am approaching our 1 year wedding anniversary. I can’t believe everything that has changed. We finally have his bio-metric appointment, and should have his permit to work and travel shortly after that. There will still be a final interview, but at least he will be able to move about freely in the US.

It is more than that though. This has been a journey and process for him as well, leaving his country, his friends, his family. acclimation to the US. Having his web-based business become successful. But mostly a journey of the spirit for him and us. Before, I did the traveling. I took assignments and worked in the US while he stayed at home in Mexico. Then everything changed and we moved here. Still, we live on the border, and it is much like being half in Mexico and half in the US. I continued as agency, and PRN at 2 jobs. I then took a full-time position for benefits, and continue PRN agency at the other hospital.

It was a wake up call for me as well with taking the permanent position. The first one I have had in several years. I don’t like it. I don’t like the politics, the crap, the people. I am so tired of the stagnate medicine, the ongoing issues that never seem to resolve. My heart yearns to travel again, to explore new places, meet new people. I have the soul of a travel nurse. I never want to stop learning.

I also am battling personal illness. Which is another reason I took this position, so I could have health benefits. All the years of playing fast and loose with my health, working 80 hours a week, have caught up with me finally. I can’t anymore. So in the end right now its better that I am stuck. It is forcing me to take care of myself for the first time in years.

I have learned something important about my husband though with this. After coming home from a particularly vile experience with work, with nasty awful hateful backstabbing people, I was heart-sick. I didn’t want to be here anymore, working in such an untenable place. I told him I just don’t want to be here anymore. he turned to me and said “that is ok honey, WE don’t have to be, we aren’t going to be here forever”. This was revolutionary for him. He had reached the point where he is ok with leaving the border, leaving his comfort zone, exploring new cities, going further into the US. Leaving his family. This is huge. He is with me, completely, whole heartedly, now and forever. To travel with me, as he only needs internet to work. This was so freeing for me. Took a huge weight off my chest, and made everything bearable again. A light at the end of the tunnel so to speak. To know that my love is with me, at my back, to go where I go, be where I am, together.

I still need to take care of business first. I need to get my health together, and then plan smart to travel again. We will keep our house here, perhaps take short-term assignments with a company that offers benefits for sure. My dream is to work just 3 days a week, take online classes, and travel to exotic locals for short assignments. Come home, work PRN  a day or two here and there, then back out to travel again. Heaven! The exciting thing is it looks like it really will happen. Now I just need to decide where to first! the sky is the limit!

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What a Week

So this week has been overwhelming to say the least. I have felt pulled and torn in multiple directions on a daily basis. It has seemed as though everyone has had a criticism of me this week. I have felt at times as though my very character is being questioned. This is demoralizing beyond belief.

I still work with amazing people. But management and the doctors have been just difficult as hell to work with lately. I am finding that the things I value the most about my nursing are being questioned and criticized. I am a person who gives a crap. I can’t help it. I try to not at times, but it is just contrary to my nature. This week, I was questioned for my dedication to my job- that I shouldn’t be helping people so much that I have to clock out on time. I also shouldn’t speak when the work situation is intolerable.
Later this week, I was told I was too emotionally attached to my patients. This was for trying to report issues going on to the doctor. The long and the short of it, is I realized today that this patient was being discriminated against for being unfunded. Apparently we are only aggressive and proactive with 90 year old people with insurance. If you are young but critically ill without money, you are screwed. Sometimes I feel so impotent at work I want to scream.

At least there is balance of good and bad. I saw some truly amazing and beautiful moments. I was blessed enough to witness a wife holding her husband and saying goodbye. She let him go, even when it was hard. To see the amount of love in that room, was a profound experience. The best that we can hope for in this life, is that someone loves us enough to do that. To be both on the giving and receiving end of that. To love and be loved, to draw our last breaths on this earth while resting in the arms of our loved ones. How someone cannot be moved by that, escapes me.

Yet, I find myself being criticized for being filled with wonder at what an amazing and fragile world we live in. How often to we circle one another, never truly connecting? How often do we hold back, not expressing our love and gratitude for the experiences we have on this earth? Why do we take this all for granted?
I am a sentimental person. I cannot help this. It is who and what I am. But perhaps I need to explore another direction in my life. I feel like I am spinning my wheels and getting nowhere. Life is too short for this.

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Nursing the Computer

So, we are experiencing a number of changes going on at work. We have a new CNO, and she is wanting to implement new procedures and policies. Additionally, our manager is currently out, and someone else is covering her. We have been under a tremendous amount of pressure, with these new changes, to make it work. We have recently hired a spate of new grads into the ICU, as well as new agency nurses. Recently our interim director had a “come to Jesus” talk with us. I found it to be quite punitive in nature, and completely unrealistic.

Concern has been voiced over the slacking in documentation within the ICU. We utilize an antiquated computer documentation system that is neither user friendly nor time saving. It is bulky, unwieldy, and a challenge for even the most computer savvy people to use. We do primary care nursing in the ICU, which includes all personal care, medication, monitoring, etc. We often do not have a secretary and must enter all our own orders. We answer the phones, draw labs, turn and reposition, document, coordinate care with families, transfer patients, call doctors and implement the plan of care. We are responsible for several aspects of cleaning of equipment and rooms, and must do everything FAST. It is not uncommon to completely turn your patient assignment around several times during your “12” hour shift. I say 12 hours in quotations because nobody I know ever leaves on time.

Unlike the medical units, we do not have CNA’s. We do not have a free charge nurse. If you are charge nurse, you have a full patient load, and sometimes the sickest ones at that. During the day there are additional meetings, rounding and responsibilities as charge nurse. Most of us despise being charge nurse, because basically in the words of my dear coworker “you are everyone’s bitch”. The people I work with, however, are amazing. They are truly some of the best people I have ever had the honor to be in the trenches with. They maintain an awesome sense of humor despite being in a war zone everyday. 99.% of them truly care about their patients and their job. Yes,  .5% are clueless, and .5% just totally annoying. but all in all, pretty darn good odds for a hospital full of strong personalities.

In addition to new constraints being placed on us to increase our speed of transfers, we are being asked to increase our documentation. we already document 2 shift assessments, hourly vital signs, hourly I&O’s, any interventions, meds, critical labs and need to contact the doctor. we transport our patients to all procedures and document on this. We are now being asked to document focus assessments every 2 hours on every system that is not within normal limits. That would be every system on our patient. Now, most nurses are constantly assessing their patients. we assess and intervene and evaluate continuously. The difference is to now go into the horribly time consuming computer system and document this, even if nothing has changed and we are doing no interventions. This is the complete opposite of the idea of “charting by exception”.

I recently read an article regarding some new legislation pending in 2 different states regarding mandating advance nursing degrees for all RN’s. This is the path leading to reimbursement, they say. I see a striking similarity to these pending legislations and the conversations being held in my job. It is all about justifying a reimbursement rate. Core Measures are mandated by regulatory committees, which failure to adhere to leads to financial consequences for the institution. Many diagnosis if acquired while in the hospital, will result in non payment for their treatment if the documentation is not there for its preexistence prior to hospitalization. The bottom line is, while higher standards of care for less money are being demanded, nurses are no longer taking care of the patients, but instead being asked to nurse the computer. We are wanted for our documentation in order to secure payment for the hospitals. We are asked to police the doctors, not to ensure safe care, but to make them document and order the required products and tests to ensure financial reimbursement. The very skills that make nurses invaluable- the eyes and ears present at the bedside, are being pushed further and further away.

I wish I knew what the answer was. I understand where this is coming from, and I do not fault them. Medicine in this country is still a business, and it needs to be financially stable in order to keep functioning. Health care costs are spiraling out of control, and the drain on our society is climbing. People want access to affordable, quality health care, and nurses want to give this. Administrators are responding to pressure from all sides to somehow make it work. I do however, think that everyone is running like chickens “the sky is falling the sky is falling”, and rather than calmly taking things back to basics, are standing with a finger in the dyke while the tsunami washes over the top. Nurses need to take back control of nursing. We need to be setting the standards, writing the requirements, and holding each other accountable to a higher level of care. We need to remember what we came into nursing for, and find a way to stop making things so freaking hard. Otherwise, who will be left to care for us?

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Today is the Day

Well, I finally made it to Hawaii. for those who don’t follow me on facebook or twitter, I am on the cusp of huge changes. I am getting married today.

It’s funny..as I wake up today I think about, what makes today different from any other day? We have been together almost 6 years. Why should doing this make any difference? Yet it does. There is something about getting married, an added layer of legitimacy to the relationship, a validation of sorts. Part of me is so excited for this, to have this moment in time where I can say beyond a doubt that this is the person I choose to be with, let no one come between us. And yet, there is part of me that is scared to death. I was married once before, for about 5 minutes it seems like. the divorce process took longer than the marriage lasted. I had no interest in ever getting married again. I was badly hurt, and it seemed to me to be the ultimate lie. I never thought I would ever meet someone that I wanted to do that with ever again. I realized 2 nights ago when we landed and I was feeling so anxious what that was. I have no doubt that I love this man, and he loves me. Yes we have had hard times, and ups and downs. Things are never perfect. But I am human, and I am scared of being hurt. I do not ever want to suffer like I once did, to feel your world crumble beneath you as the person you gave your heart to crushes it and throws it back in your face.

The avoidance of pain is one of the strongest instincts a human can have. But what happens when that instinct becomes the driving force in your life? What opportunities get missed because one is afraid of being hurt? Of making the wrong choice? Ultimately, I do not have any regrets. When I think back on my life, good and bad, it has made me who I am today and that is a pretty awesome person. I have the fortitude and determination to tackle anything in life that comes my way. I have a compassion born from having suffered, an ability to connect with humans by placing myself in their shoes. I have a passion for life that can only come from almost losing it. And I have a capacity to love that is infinite.

These experiences in my life have shaped me, have molded me, have given me so much. I do not have to let fear and anxiety rule me, but can instead choose the path of acceptance and hope. For me, that is the ultimate power of leading a life not run on fear but on love. Today is the ultimate manifestation of that trust in the universe, taking the next step on the amazing journey of mine. To all of those who have impacted my life, I thank you. And to those of you that I have not yet met, look out here I come!

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I Am A Work In Progress

Cultivating inner discipline is something that takes time; expecting rapid results is simply a sign of impatience. ~ The 14th Dalai Lama

This morning for a moment, I found myself repeating negative old behavior. I have recently embarked on a spiritual, emotional and physical transformation. It has been going remarkably well, however at times I do find myself slipping momentarily back into negative ways of thinking. While in the midst of pondering psycho behavior, I read the above tweet. It was exactly what I needed to hear. I have a choice, always, to engage in negative, self-destructive behavior, or I can stop. I know this, but become frustrated that I still feel my moments of craziness. Reading this reminded me that I am a work in progress. It is unrealistic of me to expect perfection, or to expect my mind/body/soul to be perfectly balanced and perfectly disciplined at all times. It is a transformation…which implies process, not achievement. I am in the process of changing my ways of being, reminding myself to approach life from a place of positivity. The very cool new thing though, is that I can see these choices, in a clear way. I can see examples on a moment by moment basis, options and opportunities for choice and growth. I can see the chance in front of me to become crazy psycho drama Sarah, or choose differently. It is becoming easier and easier to choose a different path, as opposed to the same crap as always. This to me is a gift, something that I had forgotten was possible. I am so happy and grateful that I have this chance to become different today. that I can be in touch with the real me, open to possibilities, open to love, open to peace and harmony in my life. That I can embrace that which used to scare me, and experience life to its fullest. This is what it means to truly be human, to live in the moment accepting the gift of life in its entirety. I can be free of craving, free of ownership and possession, free of jealousy and hate. I can let go of that which diminishes me, and embrace that which elevates me. Every day I can make this choice…and know that it is possible to achieve. in time, with practice. I am living in a moment of grace, and can choose to expand those moments to encompass those around me. I can let go of control, which is an illusion anyways, and just BE. I am so excited to see where this journey takes me, because I know it is about that…the journey and not the destination. For the first time in my life I can truly say that with certainty, and that is a wonderful feeling.

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The Freedom of Travel Nursing

I was dozing last night, when I had a random odd thought- travel nursing has freed me from the constraint of myself. How often do we get in a mode of being that caters to others expectations of who and what we should be? We get this idea of what nursing is, we go to school, we model ourselves after someone we admire, we get feedback from our managers that we are not meeting expectations but how often do we really get to be our most authentic selves?

This thought process was inspired by a talk I had with someone recently. I have been blessed to have met so many interesting awesome amazing people on my journeys. From random foursquare postings that have brought great friendships into my life, to coworkers whom I can honestly call friends. I have been exposed to all these truly wonderful characters, full of quirks and complexities.  But what has been the most astounding is the discoveries I have made about myself. I have discovered that I am, in truth, a social person. I truly like people, and I enjoy talking with them. I am in fact, a happy person. I don’t have to be weighed down by my past, or my notions about myself. Which most of the time are based on old judgements and suppositions garnered from negative experiences. It is possible to let go, and step outside of yourself when you are not constrained by “what everyone thinks” or “how it has always been”. By being a new person in a new place, it allows the freedom and space to try out different aspects of myself, that maybe I would have been too afraid to try before. I am not worried about judgment or opinions when I am traveling. I can be the real authentic me in a way that is not possible when surrounded by people who have expectations based on how I have always been. I do not need to feel self conscious, because I can approach each experience new, without fear of reprisals or condemnation. What is the worst that can happen? Someone will spank me and take my birthday away? They don’t like me? They decide I am annoying beyond all reason? The reality is nobody can make me feel badly about me, except for me.  It is truly liberating to be able to approach each new interaction without fear of rejection or results. to just be in the moment, full of possibilities, aware of my power to shape my experiences for the better. Maybe its a mid-life crisis thing, maybe because I am turning 40- I don’t know. but I am going to go with it. This is fun!

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Changes In The Air

Well, I had another day at work. I ended up working again with the nurse described in my last post. The day was ok. Crazy as usual. The only different thing was I tried again to discuss these issues and find resolution. I spoke with my managers, and we all had a meeting together. it was an exercise in futility. The interesting thing is, it doesn’t really matter. At this point, I do not care if he changes or not. That is on him. It did clearly illustrate some core values that I have in conflict with my managers. I do not care for their style of management, or lack thereof. The take home point was that I made the decision to move on. I will hopefully continue in a PRN capacity at this hospital, but it is time for a new assignment.

So I spoke with my agency and there is something opening up in Edinburg exactly when I need it to. Everything seems to be falling into place. I will be interviewing hopefully today for that. Orientation week will be challenging as I am working the last week of my contract here and need to start there, but I am confident I will work it out. I may not sleep, but I will work it out.

I also went and chopped more of my hair off. It is a little shorter than I wanted, but it looks cute. My hair though is almost a metaphor for my life right now- I needed to get rid of the dead ends, and it will grow back. It had become damaged and hard to manage, but I was afraid to let it go. No more. I absolutely will not live in any kind of fear. I am the one who has to live with my hair, and myself. I cannot have it to please others. It is mine and belongs to me, just as my life and profession does. My new path of eating is also going well. It has been hard to find anytime to exercise, as my work schedule has been completely insane, but at least the food is on the right track. my daily calorie count has been between 1200-1500 calories pretty consistently. I need to watch and keep up with my water intake. when we get super busy at work that tends to drop off and I notice a difference. I also need a new scale, mine is possessed or something and give me a different reading every time.

I guess though ultimately I am feeling like things are changing for the better. I feel like I have found the “secret” so to speak, at least for me. I must stay in the moment, positive, embracing all things, and loving myself. Taking that care that I give to others and applying it to myself. I deserve to be treated with respect and care, I deserve to be happy healthy and whole. Because I am awesome, and the only person who can deny me that is myself.

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Don’t Break My Zen

What an interesting week this has been. While I continue to be a nexus of possibilities, having all kinds of amazing experiences, it is fascinating to see what kind of response this elicits in people. The majority have been fabulous and supportive. Some have been inspired to start their own journey of self discovery. While yet others seem to make it their personal mission in life to pluck my very last nerve. Yesterday at work I had a uniquely challenging day. I was charge nurse, working with a very “special” nurse. While I am able to get along with him on a personal level, professionally he could infuriate Mother Theresa. This nurse always has issues with me when I am charge and he is not. It is silly really, as I am not one of those charge nurses that subscribes to the belief that somehow I am really in charge of anything. The truth is, we all hold licenses, we all are accountable, we are all employed, and we all had to pass a drug test to be there. As far as I am concerned, manage your own crap. It is not my job to chase you, or be a hall monitor. It simply means I give bed assignments, and fill out the charge report sheet. I am always a resource and a team player, so nothing in that changes by me being “in charge”. I don’t particularly care how people do things, just get your job done and let’s have a good day.

This gentleman does not subscribe to my philosophy on anything. not on nursing, not on being charge, not on a thing. He started out the day cranky because he was not charge nurse, I was. It went downhill from there. no matter what I did, how I tried, he was impossible. and to make things worse, he wouldn’t even allow me to try to fix things, or resolve any issues we were having. he would just throw my words back in my face, literally. The truly funny thing, is all of the things he complains about in others, he manifests in himself to a tee. And he was not content until he pushed me to the point of tears. He literally broke my zen. It was as though he took upon himself a personal challenge to burst my happy bubble. The more I tried to breathe deep and seek peace, the more he pushed. Takes some talent, really. One could admire his determination to piss me off, if it wasn’t so annoying. By the end of the day, I was frazzled, frustrated, exhausted beyond all reason, and so DONE. If I could have packed my stuff and walked out never to return again, I would have. I have zero tolerance for unprofessional dramatics. it is an unbelievable waste of time and energy.

The odd thing was, this persons antics really have helped me. It has further cemented my belief that there is a path for me, and that path does not include being like him. I had become complacent to a certain extent- content in the job location, settled so to speak. it was easier to just keep renewing my contract, even if I am not being stimulated and challenged. This is not the person I wish to be. I never want to be complacent in my job or any aspect of my life. I needed a stick to remind me that there is more for me out there, new experiences and new people to meet. I never need to live in a state of fear or anxiety. I do not need to choose to remain in an intolerable work environment. While I genuinely and truly like and respect the majority of people I work with, I have some fundamental issues with my work place. Unfortunately the biggest one of them all, is the fact that status quo is maintained. I think Clara Barton, the founder of the American Red Cross said it best-  “I have an almost complete disregard of precedent, and a faith in the possibility of something better. It irritates me to be told how things have always been done. I defy the tyranny of precedent. I go for anything new that might improve the past.”

I will have to work with this person tomorrow again. But I think I shall thank him. I will thank him for the gift of shaking things up for me, reminding me that I have a higher purpose in life, and motivating me that much more to achieve it. I am the captain of my own destiny, and no person shall deny me that right. As I said to him yesterday, and will say again tomorrow- you’re not the boss of me. I also think I will take some earphones and soothing music along..just to be on the safe side.

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Respect in Nursing

• No man, not even a doctor, ever gives any other definition of what a nurse should be than this — ‘devoted and obedient.’ This definition would do just as well for a porter. It might even do for a horse. It would not do for a policeman.  Florence Nightengale, [1859]

I just read an article entitled “How to get the credit you deserve during Nurses Week”. Once again, I am angered and feel that nurses are being taken advantage of. The article quotes a person (with multiple letters and credentials after her name of course) “A nurse is valued for her ability to coordinate care among the team, when working with other disciplines, what does it say to the group that the nurse is the least educated among them?” The article went on to conclude that the only way for nurses to attain more respect from administration, patients, their co workers and the almighty physician, was to advance her education. Anyone surprised that this article was promoted by an online education program? that within the body of the article itself was a commercial for a school?

That single quote above, made me angrier than I have been in a long time. Do we work in a place where we walk around with bar codes on our chests, that if you scan them tells us our content including our educational status and expiration date? Because I do not hold advanced degrees that somehow makes me less credible and less worthy? really? The best nurse I know, the nurse I respect and admire beyond everyone, is a diploma nurse from Scotland. She has been doing this since she is 16 years old. And god bless her, she is of an age that you do not ask her age. I adore this woman, I respect her tremendously, and I use her as a resource. She has retained compassion and care as the core of her health care delivery method. She is an amazing nurse, and the best asset to our unit that we have. Everyone is thrilled she has returned to the ICU from cath lab.

The supposition that critical thinking skills can only be achieved via an institute of higher learning pontificating at me to the tune of 40K is ludicrous. I have respect in my work environment because I create an atmosphere of competency, compassion, knowledge, and approachability. I have respect from my coworkers because I treat others with respect. I have respect from the members of the health care delivery team because I demonstrate the ability to participate in the system. I educate myself on the disease processes of my patients, I become in tune with what is needed to help them along the path and assist them in their recovery. I act as a resource and help those around me. they are ALL our patients.

The role of the nurse in the health care team as I see it, is to interpret the physician’s orders, implement them, observe and evaluate, report back to the physician the results, and make recommendations based on those observations. It is the ultimate scientist. The physician sets up the theory, we observe for results.  You need to be able to ask questions, both of your patients and the doctor, in order to uncover the information needed to help the patient progress. The amazing bonus to this job, is we get to do this with people, not in some cold sterile lab. We are working with humans, full of all their complexities and emotions. We get to hug people and love them. This is why I became a nurse, because it is a profession that demands the combined usage of my brain and heart. The human component cannot be denied.

I am respected in my profession today, because I conduct myself in such a way that it cannot be denied. I do not hold any advanced degrees. I have an Associates of Science in Nursing. I have worked across many aspects of nursing, from direct patient care to administration. The reason I am respected for what I do, is I manifest competent compassionate care. I am able to discern what needs to be done in order to accomplish the goals for the patient. Whether that is discovering that the patient has nightmares from a bad childhood, thus she does not sleep well and has anxiety problems interfering with her recovery, or anticipating what information the physician will need during rounds and having that readily available for them. Have I had times where I am disrespected? Of course. We all have encountered that doctor who is “special”. However the majority of the time, I have discovered that it is because the doctor does not know me, therefore lacks trust in me. If I continue to demonstrate a primary focus of care and concern for the patient, combined with the ability to observe and report, respect comes. It is really that simple. And I do not need an advanced practice degree for that.

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